SECTION I: Personal Information
Full Name (include MI):
Nickname:
Email:
Where do you prefer to receive
snail mail?
Home Address (Street, City,
Zip Code):
You reside in which County?
Phone (Home):
Fax (Home):
Job Title:
Current Employer:
Length of time at Current
Employer:
Employment Address (Street,
City, Zip Code):
Phone (Work):
Fax (Work):
How were you informed of LNH?
Please list any other Leadership
programs you may have completed (including location and
graduation date):
Would you consider participating
in the next LNH class (2009-2010) if space is not available
this year?
SECTION II: Current Employment
Briefly describe your job
responsibilities:
What do you consider to be
your most significant contribution or achievement related
to your work?
SECTION III: Prior Employment
Please list past employers,
titles, and dates of employment:
SECTION IV: Education
Please list your educational
background.
SECTION V: Civic Involvement
Please
list, in order of importance to you: civic, religious,
political, professional, social and other activities:
Why did you
become involved with the organizations that you feel are
the most important to you? What have you learned
from your involvement? NOTE: If you haven't been
previously involved in community life, what has changed
to allow more involvement now?
SECTION VI: Short Essay
What do you think are the three most important issues impacting New Hampshire and why? (200 words or less)
SECTION VII: References
Please list the names, addresses,
e-mail and phone numbers of your two (2) references (please
make sure that one is from your present employer, if applicable).
Choose individuals who are knowledgeable about your leadership
potential and performance.
Please have these two people
send their letters of recommendation directly to the LNH
office at: Two Delta Drive, Suite 302. Concord, NH 03301
SECTION VIII: Commitment to LNH
Please
read the following section and each of its parts. You
will be asked at the end to check that you support each
of these sections, and that you understand and are in
full agreement with them. Your application will not be
considered complete until you have completed this section.PROGRAM: Leadership New Hampshire's sessions take
place on weekdays from September through May. Program
days run from 8AM - 5PM, with three "overnight" sessions.
The Program begins with an evening reception in
June and an overnight retreat in September. Participation
in the September retreat is mandatory. Associates
also have monthly Action Assignments throughout the year
of approximately 2-6 hours. Each program session
require approximately 2-4 hours of selected readings.
Associates are encouraged to outline their personal learning
goals, and to track progress on these goals during the
year. To graduate, participants must attend
at least 10 days in their entirety. Candidates
should have the support and commitment of their employers.
Due to space and insurance considerations, participants
may not bring dependents to the program sessions. TUITION: $3,500 Tuition covers lectures and meals associated
with each program day, as well as the cost of overnight
accommodations at the retreat. Additional costs
include: required reading materials and lodging costs
for the other "overnight" sessions. Applications
are available for Financial Aid, upon request, after application
to the program is received. A Contract for the Program will be included
with each acceptance notification, which must be signed
and returned to LNH as soon as possible. An initial payment is due by JULY
11, 2008 . Final payment will be due by the end of
AUGUST . Would you like to have Financial Aid forms
mailed to you?
NOTE: Checking this box does
not affect the consideration of your application on a
merit basis. Financial Aid Applications will only be mailed out to accepted candidates. All Financial Aid forms must be completed and returned to LNH within two weeks after you receive them in order to be considered for Financial Aid.
)SELECTION: Each class will consist of approximately
35 Associates selected from a wide range of backgrounds.
All applications will be reviewed by the Selection Committee
after input from the Interviewers, and approved by the
Leadership New Hampshire Board of Trustees. Notification
of Acceptance will be sent by the end of May, 2008.
Please
read the Policies, Procedures and
Program Dates - Remember to
check your schedule for any clashes with the the program
dates!
I
have read and understand the purposes of LNH. I understand
the commitment to Leadership New Hampshire. If selected,
I will devote the time to complete the Program. I have
the cooperation of my employer and/or all parties involved
with me for completing this course. In order for your application to be considered,
this box MUST be checked:
